Podcast
Questions and Answers
What is an important factor to assess when evaluating a patient's asthma control?
What is an important factor to assess when evaluating a patient's asthma control?
Which medication class is primarily used for long-term control of asthma?
Which medication class is primarily used for long-term control of asthma?
When teaching a patient about inhaler technique, which method is recommended?
When teaching a patient about inhaler technique, which method is recommended?
What comorbidity should be evaluated for its potential effect on asthma control?
What comorbidity should be evaluated for its potential effect on asthma control?
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During an asthma assessment, which aspect of patient lifestyle is critical to inquire about?
During an asthma assessment, which aspect of patient lifestyle is critical to inquire about?
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What is a recommended practice for patients with asthma when pollen counts are high?
What is a recommended practice for patients with asthma when pollen counts are high?
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Which of the following statements about nonpharmacologic therapy in asthma management is true?
Which of the following statements about nonpharmacologic therapy in asthma management is true?
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What type of assessment should individuals with asthma undergo to identify allergens?
What type of assessment should individuals with asthma undergo to identify allergens?
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How does patient education impact asthma management?
How does patient education impact asthma management?
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What is an important strategy to manage outdoor allergens for asthma patients?
What is an important strategy to manage outdoor allergens for asthma patients?
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Study Notes
Asthma
- Asthma is a chronic airway disorder characterized by airway inflammation, hyperresponsiveness, and airflow obstruction.
- Common symptoms include wheezing, shortness of breath, chest tightness, and coughing. Symptoms vary in intensity and time.
- Asthma severity ranges from mild intermittent symptoms to severe, disabling disease.
- Acute asthma exacerbations can be life-threatening.
- International guidelines emphasize treating underlying inflammation to control asthma and reduce risks.
Epidemiology and Etiology
- Asthma is the most common chronic childhood disease and a significant cause of morbidity and mortality in adults and children.
- Worldwide, around 262 million adults and children have asthma.
- In the United States, asthma affects 8% of adults and 7% of children.
- Asthma is the primary diagnosis in millions of physician visits annually and accounts for a large portion of yearly medical costs.
- Asthma is thought to originate early in life and involves complex interactions of genetic and environmental factors (e.g., allergens, occupational sensitizers, infections, tobacco smoke, air pollution, diet, and stress).
- Host factors that increase asthma risk include genes, obesity, sex, and early growth characteristics (e.g., younger gestational age, lower birth weight, greater infant weight gain).
Pathophysiology
- Asthma is characterized by airway narrowing and inflammation in the medium-sized bronchi.
- A key feature is airway hyperresponsiveness (exaggerated narrowing in response to triggers).
- Airway narrowing is a result of smooth muscle contraction, increased mucus, and airway wall edema.
- "Th2 high" inflammation is characterized by early-onset allergic asthma, adult eosinophilic non-allergic asthma, and exercise-induced asthma. Environmental allergens trigger it, often in childhood, and is associated with allergic disease (eczema, rhinitis, food/drug allergies).
- "Th2 low" inflammation is associated with severe, adult-onset asthma, commonly triggered by viral infections, air pollution, and smoking. Obesity is also a factor.
Clinical Presentation and Diagnosis
- Asthma presentation varies from normal pulmonary function (only during acute exacerbations) to significantly reduced function (continuous symptoms).
- Symptoms can arise rapidly (within hours) or gradually over days or weeks.
- Key factors in diagnosis include a detailed medical history, physical exam (upper respiratory and skin), and measurement of expiratory airflow.
- Identifying episodic airflow obstruction, determining reversibility of obstruction, and excluding other diagnoses are critical.
- Tests such as spirometry can assess airway limitation and variability (a bronchodilator test can indicate improvement). Excessive variability in peak expiratory flow or positive exercise/bronchial challenge tests are also indicators.
- Blood tests (e.g., eosinophil count, serum IgE) may provide additional clues.
- Immunoassays can test for allergies (e.g., molds, dust mites, pollen).
- Arterial blood gases and pulse oximetry assess for hypoxemia. FeNO (fraction of exhaled nitric oxide) can reflect airway inflammation.
Treatment
- Goals: maintaining long-term control, minimizing adverse effects, achieving good symptom control, maintaining normal activity, patient satisfaction, preventing exacerbations, preventing loss of lung function.
- Non-pharmacological: Avoiding triggers like allergens, tobacco, pollution and improving emotional well-being.
- Pharmacological: Inhaled corticosteroids (ICS) are the cornerstone of long-term control for all adults and adolescents.
- Other long-term medications include LABAs, LTRAs, and LAMAS.
- Reliever medications: Short-acting beta-2 agonists (SABAs), providing quick relief from acute symptoms. ICS-formoterol and other combinations can be used for both reliever and controller. SAMAs (short acting muscarinic antagonists) may also be used.
Patient Encounter
- Details are provided from patient encounters.
- Typical patient presentations and symptoms are provided to demonstrate presentation patterns of asthma
- Treatment and management are discussed based on patient encounters
- Treatment decisions are based on symptoms, history, testing, and patient preference.
- Asthma action plans can guide self-management.
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Description
This quiz covers the basics of asthma, including its characteristics, symptoms, and severity. It also explores the epidemiology and etiology of asthma, highlighting its prevalence in both children and adults. Test your understanding of this chronic respiratory condition and its impact on health.
